NGN HESI RN Exit Exam Prep Document | 2026/2027
Edition | 250 Verified Questions
NGN HESI RN Exit Exam 2026-2027 QUESTIONS AND ANSWERS ALREADY GRADED A+.
100% Verified Solutions | Updated Per Latest NCSBN Guidelines | Graded A+
This comprehensive exam preparation document contains 250 verified questions designed to mirror the
Next Generation HESI RN Exit Exam. Each question includes detailed rationales and expert nursing
answers to reinforce clinical reasoning and test-taking strategies. The content is aligned with the latest
NCSBN Clinical Judgment Measurement Model and reflects current evidence-based practice. Ideal for
nursing students seeking a guaranteed pass on their exit exam.
Key Features:
Clinical Judgment & NGN Item Types (Bow-Tie, Trend, Cloze)
Pharmacology & Dosage Calculations
Medical-Surgical Nursing (Adult Health)
Maternal-Newborn & Pediatric Nursing
Psychiatric/Mental Health Nursing
Leadership, Delegation & Prioritization
Updates for 2026:
- Updated to reflect 2026/2027 NCSBN test plan changes
- Incorporated new NGN item formats with enhanced rationales
- Revised pharmacology content to include latest drug approvals
- Added more priority-setting and delegation scenarios
- Enhanced distractor explanations to address common misconceptions
Abstract:
The NGN HESI RN Exit Exam represents a critical milestone for nursing students transitioning to professional
practice. This 250-question preparation guide is meticulously crafted to align with the Next Generation NCLEX
framework, emphasizing clinical judgment and decision-making. Each question is accompanied by a detailed
rationale that explains not only the correct answer but also why the distractors are incorrect, fostering deep
understanding. The content spans all major nursing domains, including medical-surgical, maternal-newborn,
pediatrics, psychiatric, and leadership. Special attention is given to NGN-specific item types such as bow-tie, trend,
and cloze, ensuring familiarity with the exam format. Updated for the 2026/2027 academic year, this resource
integrates the latest evidence-based guidelines and NCSBN updates. By systematically working through these
questions, students can identify knowledge gaps, reinforce core concepts, and build confidence for exam day. The
rationales are written in a clear, scholarly tone suitable for both independent study and group review. This
document is an essential tool for achieving a high score and securing a successful nursing career.
Keywords:
NGN HESI RN Exit Exam, 250 questions with rationales, Clinical judgment, Nursing exam prep, Next Generation
NCLEX, A+ graded answers, 2026/2027 edition, Guaranteed pass
Answer Format:
Each question is followed by the correct answer and a comprehensive rationale that explains the underlying nursing
concept. Distractor explanations are provided to clarify why other options are incorrect, often highlighting common
errors or misconceptions. Rationales are structured to reinforce clinical reasoning and are written in a professional,
evidence-based style.
Compliance Checklist:
Page 1
, Aligned with NCSBN 2026/2027 test plan
Includes all NGN item types
Rationales address both correct and incorrect answers
Content reviewed by subject matter experts
Updated to reflect current evidence-based practice
Designed for self-assessment and mastery
Content Area Overview:
Content Area Questions Key Topics Weight
Clinical Judgment & NGN Item 1-40 Bow-Tie, Trend, Cloze, Highlight, 16%
Types Drag-and-Drop
Pharmacology & Dosage 41-80 Drug classifications, side effects, 16%
Calculations interactions, IV flow rates, safe dosing
Medical-Surgical Nursing 81-140 Cardiovascular, respiratory, GI, renal, 24%
endocrine, oncology, perioperative
Maternal-Newborn & Pediatric 141-180 Antepartum, intrapartum, postpartum, 16%
Nursing newborn care, pediatric growth &
development, common illnesses
Psychiatric/Mental Health 181-210 Therapeutic communication, mood 12%
Nursing disorders, anxiety, psychosis, substance
abuse
Leadership, Delegation & 211-250 Management, ethics, legal issues, 16%
Prioritization delegation, prioritization, quality
improvement
Page 2
,Q1. A patient with chronic kidney disease (stage 4) is admitted with hyperkalemia (serum potassium 6.2
mEq/L). The electrocardiogram shows peaked T waves and widened QRS complex. Which intervention
should the nurse implement first?
A. Administer sodium polystyrene sulfonate (Kayexalate) orally.
B. Administer intravenous calcium gluconate.
C. Administer intravenous regular insulin with dextrose 50%.
D. Prepare the patient for emergency hemodialysis.
Correct Answer: B. Administer intravenous calcium gluconate.
Rationale: Calcium gluconate antagonizes cardiac effects of hyperkalemia and is the priority to prevent cardiac
arrest. Kayexalate works slowly, insulin/glucose shifts potassium intracellularly but takes 15-30 minutes, and
hemodialysis is definitive but not immediately available.
Why Wrong:
A - Kayexalate is too slow for life-threatening hyperkalemia with ECG changes.
C - Insulin/glucose is effective but not first-line when ECG changes are present; calcium is given first.
D - Hemodialysis is definitive but not immediately available; calcium must be given first.
Reference: Lehne, R.A. (2026). Pharmacology for Nursing Care, 12th Ed., Ch. 52
Q2. A nurse is caring for a patient with a pulmonary embolism who is receiving a heparin infusion. The
aPTT is 120 seconds (control 30 seconds). The patient develops hematuria and has a sudden onset of severe
lower back pain. What is the nurse's priority action?
A. Administer vitamin K intramuscularly.
B. Administer protamine sulfate intravenously.
C. Stop the heparin infusion and notify the healthcare provider.
D. Administer fresh frozen plasma.
Correct Answer: B. Administer protamine sulfate intravenously.
Rationale: The patient likely has retroperitoneal hemorrhage due to supratherapeutic heparin (aPTT >100).
Protamine sulfate immediately reverses heparin. Vitamin K reverses warfarin, not heparin. Stopping heparin alone
is insufficient; reversal is needed. FFP is not first-line for heparin reversal.
Why Wrong:
A - Vitamin K reverses warfarin, not heparin.
C - Stopping heparin is important but reversal with protamine is the priority.
D - Fresh frozen plasma is used for warfarin reversal or coagulopathy, not heparin reversal.
Reference: Lehne, R.A. (2026). Pharmacology for Nursing Care, 12th Ed., Ch. 36
Q3. A patient with type 2 diabetes mellitus is admitted with hyperglycemic hyperosmolar state (HHS). Serum
glucose is 650 mg/dL, serum osmolality 340 mOsm/kg, and serum sodium 148 mEq/L. Which intravenous
fluid should the nurse anticipate administering first?
A. 0.9% sodium chloride at 15 mL/kg/hour
B. 0.45% sodium chloride at 15 mL/kg/hour
C. 5% dextrose in water at 100 mL/hour
D. Lactated Ringer's solution at 250 mL/hour
Correct Answer: A. 0.9% sodium chloride at 15 mL/kg/hour
Rationale: In HHS, initial fluid resuscitation is with 0.9% normal saline to correct hypovolemia and
hyperosmolality. 0.45% saline is used after volume status improves. D5W would worsen hyperglycemia. Lactated
Ringer's contains lactate which can be converted to glucose.
Why Wrong:
B - 0.45% saline is hypotonic and used later once volume is restored.
C - D5W would increase serum glucose.
D - Lactated Ringer's contains lactate which may worsen hyperglycemia.
Page 3
, Reference: American Diabetes Association. (2025). Hyperglycemic Crises in Adults With Diabetes: A Consensus Report.
Diabetes Care.
Q4. A patient with a traumatic brain injury has an intracranial pressure (ICP) monitor showing sustained
pressure of 28 mm Hg. The nurse notes the patient is posturing with arms flexed and legs extended. What is
the nurse's priority intervention?
A. Administer mannitol 0.5 g/kg intravenously over 30 minutes.
B. Elevate the head of bed to 30 degrees and maintain head midline.
C. Administer propofol infusion for sedation.
D. Hyperventilate the patient to a PaCO2 of 25-30 mm Hg.
Correct Answer: B. Elevate the head of bed to 30 degrees and maintain head midline.
Rationale: Elevating HOB and maintaining head midline promotes venous drainage and reduces ICP. Mannitol is
indicated but nursing intervention first is positioning. Propofol may be used but not priority. Hyperventilation is
reserved for acute ICP crisis but can cause ischemia.
Why Wrong:
A - Mannitol is a medical order but positioning is the immediate nursing action.
C - Propofol may lower ICP but requires provider order and is not first-line nursing intervention.
D - Hyperventilation is used only for acute ICP spikes; it can cause vasoconstriction and ischemia.
Reference: Hickey, J.V. (2024). The Clinical Practice of Neurological and Neurosurgical Nursing, 8th Ed., Ch. 14
Q5. A nurse is evaluating a patient's readiness for discharge after a myocardial infarction. The patient's
spouse asks about resuming sexual activity. Which response by the nurse is most appropriate?
A. Sexual activity can resume when you can climb two flights of stairs without symptoms.
B. Sexual activity should be avoided for at least 6 weeks to prevent reinfarction.
C. It is safe to resume sexual activity once the patient's blood pressure is controlled.
D. Sexual activity is not recommended after a heart attack due to risk of sudden death.
Correct Answer: A. Sexual activity can resume when you can climb two flights of stairs without symptoms.
Rationale: Guidelines suggest sexual activity can resume when the patient can perform moderate physical activity
(e.g., climbing two flights of stairs) without chest pain or dyspnea. This indicates adequate cardiac reserve.
Avoidance for 6 weeks is outdated; blood pressure control alone is insufficient; risk is low if stable.
Why Wrong:
B - Avoidance for 6 weeks is outdated; most patients can resume within 2-4 weeks if stable.
C - Blood pressure control is important but not the sole criterion; functional capacity is key.
D - Sexual activity is not contraindicated; risk is low in stable patients.
Reference: American Heart Association. (2024). Sexual Activity After Heart Attack. Circulation.
Q6. A patient with cirrhosis and ascites is prescribed spironolactone 100 mg daily. The nurse notes the
patient's serum potassium is 5.8 mEq/L. Which action should the nurse take?
A. Administer the spironolactone as prescribed and monitor potassium levels.
B. Hold the spironolactone and notify the healthcare provider.
C. Administer furosemide 40 mg intravenously to promote potassium excretion.
D. Administer sodium polystyrene sulfonate orally to lower potassium.
Correct Answer: B. Hold the spironolactone and notify the healthcare provider.
Rationale: Spironolactone is a potassium-sparing diuretic; with hyperkalemia (K+ >5.5), it should be held to avoid
life-threatening arrhythmias. The provider should be notified for alternative therapy. Furosemide may be used but
not without order. Kayexalate is not first-line for mild hyperkalemia.
Why Wrong:
A - Administering spironolactone with hyperkalemia risks cardiac arrest.
C - Furosemide requires a provider order and is not the immediate priority.
Page 4
Edition | 250 Verified Questions
NGN HESI RN Exit Exam 2026-2027 QUESTIONS AND ANSWERS ALREADY GRADED A+.
100% Verified Solutions | Updated Per Latest NCSBN Guidelines | Graded A+
This comprehensive exam preparation document contains 250 verified questions designed to mirror the
Next Generation HESI RN Exit Exam. Each question includes detailed rationales and expert nursing
answers to reinforce clinical reasoning and test-taking strategies. The content is aligned with the latest
NCSBN Clinical Judgment Measurement Model and reflects current evidence-based practice. Ideal for
nursing students seeking a guaranteed pass on their exit exam.
Key Features:
Clinical Judgment & NGN Item Types (Bow-Tie, Trend, Cloze)
Pharmacology & Dosage Calculations
Medical-Surgical Nursing (Adult Health)
Maternal-Newborn & Pediatric Nursing
Psychiatric/Mental Health Nursing
Leadership, Delegation & Prioritization
Updates for 2026:
- Updated to reflect 2026/2027 NCSBN test plan changes
- Incorporated new NGN item formats with enhanced rationales
- Revised pharmacology content to include latest drug approvals
- Added more priority-setting and delegation scenarios
- Enhanced distractor explanations to address common misconceptions
Abstract:
The NGN HESI RN Exit Exam represents a critical milestone for nursing students transitioning to professional
practice. This 250-question preparation guide is meticulously crafted to align with the Next Generation NCLEX
framework, emphasizing clinical judgment and decision-making. Each question is accompanied by a detailed
rationale that explains not only the correct answer but also why the distractors are incorrect, fostering deep
understanding. The content spans all major nursing domains, including medical-surgical, maternal-newborn,
pediatrics, psychiatric, and leadership. Special attention is given to NGN-specific item types such as bow-tie, trend,
and cloze, ensuring familiarity with the exam format. Updated for the 2026/2027 academic year, this resource
integrates the latest evidence-based guidelines and NCSBN updates. By systematically working through these
questions, students can identify knowledge gaps, reinforce core concepts, and build confidence for exam day. The
rationales are written in a clear, scholarly tone suitable for both independent study and group review. This
document is an essential tool for achieving a high score and securing a successful nursing career.
Keywords:
NGN HESI RN Exit Exam, 250 questions with rationales, Clinical judgment, Nursing exam prep, Next Generation
NCLEX, A+ graded answers, 2026/2027 edition, Guaranteed pass
Answer Format:
Each question is followed by the correct answer and a comprehensive rationale that explains the underlying nursing
concept. Distractor explanations are provided to clarify why other options are incorrect, often highlighting common
errors or misconceptions. Rationales are structured to reinforce clinical reasoning and are written in a professional,
evidence-based style.
Compliance Checklist:
Page 1
, Aligned with NCSBN 2026/2027 test plan
Includes all NGN item types
Rationales address both correct and incorrect answers
Content reviewed by subject matter experts
Updated to reflect current evidence-based practice
Designed for self-assessment and mastery
Content Area Overview:
Content Area Questions Key Topics Weight
Clinical Judgment & NGN Item 1-40 Bow-Tie, Trend, Cloze, Highlight, 16%
Types Drag-and-Drop
Pharmacology & Dosage 41-80 Drug classifications, side effects, 16%
Calculations interactions, IV flow rates, safe dosing
Medical-Surgical Nursing 81-140 Cardiovascular, respiratory, GI, renal, 24%
endocrine, oncology, perioperative
Maternal-Newborn & Pediatric 141-180 Antepartum, intrapartum, postpartum, 16%
Nursing newborn care, pediatric growth &
development, common illnesses
Psychiatric/Mental Health 181-210 Therapeutic communication, mood 12%
Nursing disorders, anxiety, psychosis, substance
abuse
Leadership, Delegation & 211-250 Management, ethics, legal issues, 16%
Prioritization delegation, prioritization, quality
improvement
Page 2
,Q1. A patient with chronic kidney disease (stage 4) is admitted with hyperkalemia (serum potassium 6.2
mEq/L). The electrocardiogram shows peaked T waves and widened QRS complex. Which intervention
should the nurse implement first?
A. Administer sodium polystyrene sulfonate (Kayexalate) orally.
B. Administer intravenous calcium gluconate.
C. Administer intravenous regular insulin with dextrose 50%.
D. Prepare the patient for emergency hemodialysis.
Correct Answer: B. Administer intravenous calcium gluconate.
Rationale: Calcium gluconate antagonizes cardiac effects of hyperkalemia and is the priority to prevent cardiac
arrest. Kayexalate works slowly, insulin/glucose shifts potassium intracellularly but takes 15-30 minutes, and
hemodialysis is definitive but not immediately available.
Why Wrong:
A - Kayexalate is too slow for life-threatening hyperkalemia with ECG changes.
C - Insulin/glucose is effective but not first-line when ECG changes are present; calcium is given first.
D - Hemodialysis is definitive but not immediately available; calcium must be given first.
Reference: Lehne, R.A. (2026). Pharmacology for Nursing Care, 12th Ed., Ch. 52
Q2. A nurse is caring for a patient with a pulmonary embolism who is receiving a heparin infusion. The
aPTT is 120 seconds (control 30 seconds). The patient develops hematuria and has a sudden onset of severe
lower back pain. What is the nurse's priority action?
A. Administer vitamin K intramuscularly.
B. Administer protamine sulfate intravenously.
C. Stop the heparin infusion and notify the healthcare provider.
D. Administer fresh frozen plasma.
Correct Answer: B. Administer protamine sulfate intravenously.
Rationale: The patient likely has retroperitoneal hemorrhage due to supratherapeutic heparin (aPTT >100).
Protamine sulfate immediately reverses heparin. Vitamin K reverses warfarin, not heparin. Stopping heparin alone
is insufficient; reversal is needed. FFP is not first-line for heparin reversal.
Why Wrong:
A - Vitamin K reverses warfarin, not heparin.
C - Stopping heparin is important but reversal with protamine is the priority.
D - Fresh frozen plasma is used for warfarin reversal or coagulopathy, not heparin reversal.
Reference: Lehne, R.A. (2026). Pharmacology for Nursing Care, 12th Ed., Ch. 36
Q3. A patient with type 2 diabetes mellitus is admitted with hyperglycemic hyperosmolar state (HHS). Serum
glucose is 650 mg/dL, serum osmolality 340 mOsm/kg, and serum sodium 148 mEq/L. Which intravenous
fluid should the nurse anticipate administering first?
A. 0.9% sodium chloride at 15 mL/kg/hour
B. 0.45% sodium chloride at 15 mL/kg/hour
C. 5% dextrose in water at 100 mL/hour
D. Lactated Ringer's solution at 250 mL/hour
Correct Answer: A. 0.9% sodium chloride at 15 mL/kg/hour
Rationale: In HHS, initial fluid resuscitation is with 0.9% normal saline to correct hypovolemia and
hyperosmolality. 0.45% saline is used after volume status improves. D5W would worsen hyperglycemia. Lactated
Ringer's contains lactate which can be converted to glucose.
Why Wrong:
B - 0.45% saline is hypotonic and used later once volume is restored.
C - D5W would increase serum glucose.
D - Lactated Ringer's contains lactate which may worsen hyperglycemia.
Page 3
, Reference: American Diabetes Association. (2025). Hyperglycemic Crises in Adults With Diabetes: A Consensus Report.
Diabetes Care.
Q4. A patient with a traumatic brain injury has an intracranial pressure (ICP) monitor showing sustained
pressure of 28 mm Hg. The nurse notes the patient is posturing with arms flexed and legs extended. What is
the nurse's priority intervention?
A. Administer mannitol 0.5 g/kg intravenously over 30 minutes.
B. Elevate the head of bed to 30 degrees and maintain head midline.
C. Administer propofol infusion for sedation.
D. Hyperventilate the patient to a PaCO2 of 25-30 mm Hg.
Correct Answer: B. Elevate the head of bed to 30 degrees and maintain head midline.
Rationale: Elevating HOB and maintaining head midline promotes venous drainage and reduces ICP. Mannitol is
indicated but nursing intervention first is positioning. Propofol may be used but not priority. Hyperventilation is
reserved for acute ICP crisis but can cause ischemia.
Why Wrong:
A - Mannitol is a medical order but positioning is the immediate nursing action.
C - Propofol may lower ICP but requires provider order and is not first-line nursing intervention.
D - Hyperventilation is used only for acute ICP spikes; it can cause vasoconstriction and ischemia.
Reference: Hickey, J.V. (2024). The Clinical Practice of Neurological and Neurosurgical Nursing, 8th Ed., Ch. 14
Q5. A nurse is evaluating a patient's readiness for discharge after a myocardial infarction. The patient's
spouse asks about resuming sexual activity. Which response by the nurse is most appropriate?
A. Sexual activity can resume when you can climb two flights of stairs without symptoms.
B. Sexual activity should be avoided for at least 6 weeks to prevent reinfarction.
C. It is safe to resume sexual activity once the patient's blood pressure is controlled.
D. Sexual activity is not recommended after a heart attack due to risk of sudden death.
Correct Answer: A. Sexual activity can resume when you can climb two flights of stairs without symptoms.
Rationale: Guidelines suggest sexual activity can resume when the patient can perform moderate physical activity
(e.g., climbing two flights of stairs) without chest pain or dyspnea. This indicates adequate cardiac reserve.
Avoidance for 6 weeks is outdated; blood pressure control alone is insufficient; risk is low if stable.
Why Wrong:
B - Avoidance for 6 weeks is outdated; most patients can resume within 2-4 weeks if stable.
C - Blood pressure control is important but not the sole criterion; functional capacity is key.
D - Sexual activity is not contraindicated; risk is low in stable patients.
Reference: American Heart Association. (2024). Sexual Activity After Heart Attack. Circulation.
Q6. A patient with cirrhosis and ascites is prescribed spironolactone 100 mg daily. The nurse notes the
patient's serum potassium is 5.8 mEq/L. Which action should the nurse take?
A. Administer the spironolactone as prescribed and monitor potassium levels.
B. Hold the spironolactone and notify the healthcare provider.
C. Administer furosemide 40 mg intravenously to promote potassium excretion.
D. Administer sodium polystyrene sulfonate orally to lower potassium.
Correct Answer: B. Hold the spironolactone and notify the healthcare provider.
Rationale: Spironolactone is a potassium-sparing diuretic; with hyperkalemia (K+ >5.5), it should be held to avoid
life-threatening arrhythmias. The provider should be notified for alternative therapy. Furosemide may be used but
not without order. Kayexalate is not first-line for mild hyperkalemia.
Why Wrong:
A - Administering spironolactone with hyperkalemia risks cardiac arrest.
C - Furosemide requires a provider order and is not the immediate priority.
Page 4
